The Ongoing Challenge of Patient Handoffs

Are patient handoffs getting better?

Considerable effort has been made to improve handoffs in the past several years, including using technology and programs like I-PASS, the mnemonic technique to help standardize the handoff process.

But challenges still occur.

A study released in 2016 estimated communication failures were responsible in part for 30% of all physician and hospital malpractice claims and 1,744 deaths over 5 years, and a number of experts believe handoffs contribute disproportionately to those failures. One reason for the communication breakdowns – the splintering of the healthcare system, which has led to more exchanges of information involving more providers.

EHRs have been both a help and a hindrance when it comes to handoffs, according to some physicians. While they have improved being able to receive more readable and accurate information, they have also been over-relied upon in some environments, creating the “cut-and-paste” phenomenon. On the flip side, criticism has been directed at too much information being entered into the system, causing a paralysis of analysis as physicians try to wade through a ton of data and information.

What can a hospital do to improve its handoffs? The Joint Commission in 2017 offered these 7 suggestions for improvement:

  1. Hospital leadership must demonstrate a commitment to improving handoffs, including providing support, time and budget to improvement initiatives.
  2. Critical content that is to be communicated (both verbally and in written form) needs to be standardized. That includes standardized tools and methods, such as forms, templates, checklists, protocols, mnemonics, etc.)
  3. Conduct face-to-face handoff communication and sign-outs in locations free from interruptions, and include multidisciplinary team members and family members as appropriate.
  4. Standardize training on how to conduct successful handoffs.
  5. Use EHR capabilities and other technologies to enhance handoffs between senders and receivers.
  6. Monitor the success of interventions and use lessons to drive improvement. This includes collecting data derived from adverse events with poor handoffs as a contributing factor, and use the data as a basis for a systematic organizational approach to performance improvement.
  7. Sustain and spread best practices in handoffs and make high-quality handoffs a cultural priority.